چکیده (انگلیسی):

Background:In 2010 policy changes were introduced to the Australian healthcare system that granted nurse
practitioners access to the public health insurance scheme (Medicare) subject to a collaborative arrangement with a
medical practitioner. These changes facilitated nurse practitioner practice in primary healthcare settings. This study
investigated the experiences and perceptions of nurse practitioners and medical practitioners who worked together
under the new policies and aimed to identify enablers of collaborative practice models.
Methods:A multiple case study of five primary healthcare sites was undertaken, applying mixed methods research.
Six nurse practitioners, 13 medical practitioners and three practice managers participated in the study. Data were
collected through direct observations, documents and semi-structured interviews as well as questionnaires
including validated scales to measure the level of collaboration, satisfaction with collaboration and beliefs in the
benefits of collaboration. Thematic analysis was undertaken for qualitative data from interviews, observations and
documents, followed by deductive analysis whereby thematic categories were compared to two theoretical models
of collaboration. Questionnaire responses were summarised using descriptive statistics.
Results:Using the scale measurements, nurse practitioners and medical practitioners reported high levels of
collaboration, were highly satisfied with their collaborative relationship and strongly believed that collaboration
benefited the patient. The three themes developed from qualitative data showed a more complex and nuanced
picture: 1) Structures such as government policy requirementsand local infrastructure disadvantaged nurse practitioners
financially and professionally in collaborative practice models; 2) Participants experienced the influence and consequences
of individual role enactment through the co-existence of overlapping, complementary, traditional and emerging roles,
which blurred perceptions of legal liability and reimbursement for shared patient care; 3) Nurse practitioners’ and medical
practitioners’ adjustment to new routines and facilitating the collaborative work relied on the willingness and personal
commitment of individuals.
Conclusions:Findings of this study suggest that the willingness of practitioners and their individual relationships
partially overcame the effect of system restrictions. However, strategic support from healthcare reform decisionmakers is needed to strengthen nurse practitioner positions and ensure the sustainability of collaborative practice
models in primary healthcare.